There was A LOT more to 5191 than most realize.
Threats to COM191:
-Outages all over the airport, including lights, signs, etc
-Markings and signs that no longer existed
-Early morning/night
-A runway sight picture that was nearly identical due to upslope than downslope of both runways; different runway materials and lights were the only visible difference, again, NO NUMBERS OR SIGNS! They were faded and OTS.
-A single controller on duty who was heads down after clearing COM191 for takeoff, he was working clearance, ground, local, AND DEPARTURE AND ARRIVAL, using the radar repeater in the tower cab.
-A taxiway that was not properly closed and NOTAM'ed CLSD. The taxiway was closed THEN the NOTAM was issued. The airport manager instead gave printouts to the station managers detailing the closure and the back-taxi procedure that was to be used. SkyWest and Eagle received theirs, Comair did not. Oops.
-A crew that was likely tired and fatigued after staying at a hotel that was under renovation at the time and crewmembers were reporting not being able to get enough rest. Where was that tidbit in the NTSB report?
Yes, it was their fault, they took off on the wrong runway, but to a wary crew they had everything against them.